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General NPI Number Information
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NPI Number | 1841588084
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Entity Type | Organization
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Legal Business Name | LANGUAGE AND SPEECH THERAPY
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Dates
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Enumeration Date | 07/20/2011
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Last Update Date | 07/20/2011
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Provider Practice Location Address
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Address Line | 12966 EUCLID ST, SUITE 550
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City | GARDEN GROVE
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State | CA
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Zip | 92840-9217
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Country | US
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Telephone | 714-539-6207
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Fax | 714-539-6209
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Provider Business Mailing Address
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Address Line | 12966 EUCLID ST STE 550
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City | GARDEN GROVE
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State | CA
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Zip | 92840-9217
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Country | US
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Telephone | 714-539-6207
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Fax | 714-539-6209
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. JULIE CHAU DIEP
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Credential | MS, CCC-SLP
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Telephone | 714-539-6207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | SP12385
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | SP12385
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License Number State | CA
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